Care of the child in a body cast

Caring for a child in a body cast is a stressful situation for most families and many families state they do not receive adequate information on how to care for their child. This paper presents a comprehensive guide on caring for a child in a body cast. It examines the physical care issues, transportation and cast care. An instrument for assessing the family’s ability to cope with caring for a child in a body cast is described, and further resources for parents and nurses are presented.     

Acute transverse myelitis in patients with systemic lupus erythematosus

The authors provide disease histories of 4 patients afflicted with genuine systemic lupus erythematosus (SLE). There were 2 men and 2 women who developed acute transverse myelitis (ATM) at an age of 24 to 31 years. Before ATM developed, SLE standing was from 3 to 10 years. Based on the authors' and reported data, the problems of the pathogenesis, clinical picture, diagnosis and prognosis in that grave complication of SLE are discussed. As for the mechanisms of ATM development, the role of antiphospholipid antibodies is reviewed. The data on familial aggravation of the patients are presented in terms of the development of the antiphospholipid syndrome in their relatives. Emphasis is laid on the necessity of early intensive care with glucocorticoid hormones and cyclophosphamide of patients with associated SLE and ATM in order to improve their prognosis.     

"It's not what you were expecting, but it's still a beautiful journey": the experience of mothers of children with Down syndrome

Aim: The purpose of this study was to describe qualitatively the experience of parenting for mothers of a child with Down syndrome and to explore what if any was the role of spirituality and organized religion in this experience. Method: A homogenous sample of eight mothers of children between 7 and 12 years of age with Down syndrome was recruited through a population-based source of families of children with Down syndrome in Western Australia. In-depth interviews were used to explore the mother's experience of parenting and to examine the role of spirituality and organized religion in their personal experience of mothering. Results: In this study, stressful life events recounted by the mothers included initial acceptance, developmental behaviour of the child, functionality of the child, health conditions and financial stress. Overall spirituality was described as a stronger and more dynamic source of support than organized religion in coping with stressors and life's challenges associated with raising a child with Down syndrome. Conclusion: Findings from this study revealed that being a mother to a child with Down syndrome can best be described as a mosaic of experiences, emotions and a journey of self growth. Both spirituality and organized religion to a greater or lesser extent were useful in mediating stress and supporting mothers particularly during challenging life events in the course of their journey with their child with Down syndrome. [Box: see text].     

Distinct domains in Nbs1 regulate irradiation-induced checkpoints and apoptosis

The chromosomal instability syndromes Nijmegen breakage syndrome (NBS) and ataxia telangiectasia (AT) share many overlapping phenotypes, including cancer predisposition, radiation sensitivity, cell-cycle checkpoint defects, immunodeficiency, and gonadal dysfunction. The NBS protein Nbs1 is not only a downstream target of AT mutated (ATM) kinase but also acts upstream, promoting optimal ATM activation, ATM recruitment to breaks, and ATM accessibility to substrates. By reconstituting Nbs1 knockout mice with bacterial artificial chromosomes, we have assessed the contribution of distinct regions of Nbs1 to the ATM-dependent DNA damage response. We find that T cell and oocyte development, as well as DNA damage-induced G2/M and S phase checkpoint arrest and radiation survival are dependent on the N-terminal forkhead-associated domain, but not on the principal residues phosphorylated by ATM (S278 and S343) or on the evolutionarily conserved C-terminal region of Nbs1. However, the C-terminal region regulates irradiation-induced apoptosis. These studies provide insight into the complex interplay between Nbs1 and ATM in the DNA damage response.     

Cyclooxygenase-2 in adipose tissue macrophages limits adipose tissue dysfunction in obese mice

Obesity-associated complications are causing increasing morbidity and mortality worldwide. Expansion of adipose tissue in obesity leads to a state of low-grade chronic inflammation and dysregulated metabolism, resulting in insulin resistance and metabolic syndrome. Adipose tissue macrophages (ATMs) accumulate in obesity and are a source of proinflammatory cytokines that further aggravate adipocyte dysfunction. Macrophages are rich sources of cyclooxygenase (COX), the rate limiting enzyme for prostaglandin E2 (PGE2) production. When mice were fed a high-fat diet (HFD), ATMs increased expression of COX-2. Selective myeloid cell COX-2 deletion resulted in increased monocyte recruitment and proliferation of ATMs, leading to increased proinflammatory ATMs with decreased phagocytic ability. There were increased weight gain and adiposity, decreased peripheral insulin sensitivity and glucose utilization, increased adipose tissue inflammation and fibrosis, and abnormal adipose tissue angiogenesis. HFD pair-feeding led to similar increases in body weight, but mice with selective myeloid cell COX-2 still exhibited decreased peripheral insulin sensitivity and glucose utilization. Selective myeloid deletion of the macrophage PGE2 receptor subtype, EP4, produced a similar phenotype, and a selective EP4 agonist ameliorated the metabolic abnormalities seen with ATM COX-2 deletion. Therefore, these studies demonstrated that an ATM COX-2/PGE2/EP4 axis plays an important role in inhibiting adipose tissue dysfunction.     

Social pathways to premenstrual symptoms

The purpose of this study was to explore feminine and menstrual socialization, expectations about experiencing symptoms, and the stressful nature of women's lives among women with three perimenstrual symptom patterns. Social learning and stress theory provided a theoretical framework for understanding why some menstruating women experience premenstrual syndrome or premenstrual magnification symptom patterns. Data about socialization, stressful life context, expectations about symptoms, depressed mood, and other health-related and demographic indicators were obtained from an interview. Subsequent daily recordings in a health diary for two or more menstrual cycles provided data with which to classify women's symptoms across the menstrual cycle as a low severity symptom (LS, n = 73), premenstrual syndrome (PMS, n = 36), or premenstrual magnification (PMM, n = 62) pattern. Stepwise discriminant function analysis demonstrated that stressful life context, menstrual socialization, and expectations about symptoms related to menstruation differentiated women with an LS from those with a PMS or PMM symptom pattern. In addition, depressed mood differentiated the three groups. ©1995 John Wiley & Sons, Inc.     

Stressful Life Events and the Metabolic Syndrome: The Prevalence, Prediction and Prevention of Diabetes (PPP)-Botnia Study

OBJECTIVE

Stress may play a role in the pathogenesis of the metabolic syndrome. However, the scant evidence available is not population-based, restricting the external validity of the findings. Our aim was to test associations between stressful life events, their accumulation, and the metabolic syndrome in a large population-based cohort. We also tested associations between stress and the individual components related to the metabolic syndrome.

RESEARCH DESIGN AND METHODS

This was a population-based, random sample of 3,407 women and men aged 18–78 years residing in Western Finland. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III and International Diabetes Federation criteria. The severity of 15 stressful life events pertaining to finance, work, social relationships, health, and housing was self-rated.

RESULTS

In comparison with subjects not reporting any extremely stressful life events, those reporting work- or finance-related events had an increased odds for having the metabolic syndrome. The risk was further increased according to accumulation of stressful finance-related events and to having at least three stressful life events in any of the life domains assessed. Accumulation of stressful life events was associated with insulin resistance, obesity, and triglycerides. The associations were not confounded by sex, age, lifestyle, or family history of diabetes.

CONCLUSIONS

Life events perceived as stressful, particularly those related to finance and work, may be a signal for poor metabolic health.Metabolic syndrome refers to a cluster of aberrations of metabolic origin that increases the risk for morbidity and mortality from type 2 diabetes (1,2), cardiovascular disease (3), and all-cause mortality (1). Features of the metabolic syndrome include a combination of impaired glucose and lipid metabolism, obesity, and hypertension (4–6). Along with the worldwide increase in the prevalence of the metabolic syndrome (7), there exists a strong need to identify underlying, causative factors that may render an individual susceptible to the metabolic syndrome.The metabolic syndrome is thought to be multifactorial in origin, arising from a combination of genetic and environmental factors (4). Among the plausible environmental factors is psychosocial stress (8). However, research on the importance of stress in the etiology of the metabolic syndrome is scanty. Vogelzangs et al. (9) found in their cross-sectional cohort study of 2,917 elderly men and women that for each experienced negative life event the odds for having the metabolic syndrome increased by 13%. In a small sample of elderly women and men (10), caregiver stress predicted metabolic syndrome at follow-up >15 years later. In the Whitehall II study of >10,000 middle-aged civil servants, chronic work stress predicted higher odds for having the metabolic syndrome at a follow-up 14 years later (11). In the Pittsburgh Healthy Women Study, middle-aged women who experienced life events as extremely stressful had an increased risk for developing the metabolic syndrome over an average 15 years of follow-up (12). In the same study marital dissatisfaction, divorce, and widowhood also predicted an increased risk for developing the metabolic syndrome over an average follow-up of 11.5 years (13).Although important, none of the studies so far have been population-based, restricting the external validity of the findings: the participants have been recruited from health care beneficiaries (9), from Alzheimer''s caregivers (10), from employees of civil service departments (11), and from initially healthy premenopausal women holding a driver''s license (12,13). Accordingly, the first major aim of this study was to test associations between severity of stressful life events arising from various life domains and the metabolic syndrome defined according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) clinical criteria in a large population-based sample of women and men residing in Western Finland. The second major aim of our study was to test the significance of stressful life events for the individual components of the metabolic syndrome.     

Duane's retraction syndrome associated with cerebral arteriovenous malformation

We have described a case of Duane's retraction syndrome in association with well documented cerebral arteriovenous malformation. This syndrome has been previously reported in association with anomalies of other parts of the body, but perusal of pertinent literature did not disclose reports of such a combination as seen in our patient.     

Abdominal compartment syndrome: an emergency department perspective

Compartment syndromes can occur in many body regions. Abdominal compartment syndrome, initially described many years ago, has become increasingly recognised in critical care patients. The key points regarding its definition, pathophysiology, aetiology and treatment are described and discussed. Abdominal compartment syndrome is defined as an intra-abdominal pressure >20 mm Hg with evidence of organ dysfunction. At risk patients should be identified in the emergency department and early monitoring of intra-abdominal pressure instituted. Interventions in the emergency department potentially contribute to the development of abdominal compartment syndrome during subsequent phases of care. The need to ensure an early multidisciplinary approach in the management of this complex condition is essential for the best possible patient outcome.     

Employed women with depression in Korea

Korean women have been reported to be more susceptible to depressive symptoms than men. In this study we explored the important predictors of depression among employed Korean women using modified Hauenstein's Nursing Practice Paradigm for Depressed Rural Women, focusing on the relationship of stressful life events and three resources (physiological, social, and psychological). In particular, we examined the moderating effects of resources on the stress-depression relationship among a community-based sample of employed Korean women. In this cross-sectional study, survey data were collected with 767 employed women in Korea over a 2-month period in 2006. Of these respondents, 286 depressed participants' data were analysed to test moderating effects of the three resources on depression. Our hierarchical multiple regression results revealed that stressful life events directly affected depression. However, after including the product terms of the three resources (i.e. regular exercise, self-efficacy, and closeness) and stressful life events, the main effect of stressful life events disappeared, confirming significant moderating effects of the resources. The findings would contribute to development of a body of culturally sensitive knowledge for clinical practice with depressed employed Korean women.     

Effect of stress on international normalized ratio during warfarin therapy

OBJECTIVE: To discuss the effect of stress on the international normalized ratio (INR) when patients are taking warfarin. CASE SUMMARY: Two patients at a pharmacist-managed anticoagulation clinic who were stable with anticoagulation developed elevated INR values after a stressful event occurred. All other factors known to elevate the INR were unchanged; furthermore, the INR values returned to the prior level of control after resolution of the stressful events. DISCUSSION: Management of anticoagulation with warfarin requires the knowledge of factors that may alter an INR. Many of these factors, such as dietary changes, illnesses, drug interactions, patient compliance, and physical activity, have been described. In spite of this understanding, many patients continue to experience variability in their INR values, suggesting there are other factors that can alter the INR that have not been fully described. The cases presented here demonstrate that stressful events, physical or psychological, can elevate the INR. The mechanism for this occurrence is unknown, but may be related to decreased metabolism of warfarin during stress. CONCLUSIONS: When an unexplained INR value exists, a stressor should be evaluated as a potential cause.     

Chromosomal abnormalities: trisomy 18, trisomy 13, deletions, and microdeletions

The birth of an infant with a chromosomal abnormality such as trisomy 18, 13, Wolf-Hirschhorn (4p-) syndrome, Cri-du-chat (5p-) syndrome, and the microdeletion syndromes creates a stressful and devastating experience for families. Many of these disorders have severe consequences encompassing major malformations and mental retardation. With increasing diagnostic accuracy, clinicians can now appreciate the wide variability and natural history of these disorders. Although many of these infants do not survive the neonatal period, others do. Neonatal nurses have the opportunity to assist families in these situations by providing anticipatory guidance and care.     

Adaptive, template moderated, spatially varying statistical classification

A novel image segmentation algorithm was developed to allow the automatic segmentation of both normal and abnormal anatomy from medical images. The new algorithm is a form of spatially varying statistical classification, in which an explicit anatomical template is used to moderate the segmentation obtained by statistical classification. The algorithm consists of an iterated sequence of spatially varying classification and nonlinear registration, which forms an adaptive, template moderated (ATM), spatially varying statistical classification (SVC). Classification methods and nonlinear registration methods are often complementary, both in the tasks where they succeed and in the tasks where they fail. By integrating these approaches the new algorithm avoids many of the disadvantages of each approach alone while exploiting the combination. The ATM SVC algorithm was applied to several segmentation problems, involving different image contrast mechanisms and different locations in the body. Segmentation and validation experiments were carried out for problems involving the quantification of normal anatomy (MRI of brains of neonates) and pathology of various types (MRI of patients with multiple sclerosis, MRI of patients with brain tumors, MRI of patients with damaged knee cartilage). In each case, the ATM SVC algorithm provided a better segmentation than statistical classification or elastic matching alone.     

The imaging of body asymmetry and hemihypertrophy

Localized soft tissue and bone overgrowth may be the result of many different causes and will vary in severity, from involvement of a single digit to one half of the body. There are a variety of causes, including chronic lymphedema; lymphangiomatous malformations; neurofibromatosis; vascular malformations including the Klippel-Trenaunay-Weber syndrome; macrodystrophia lipomatosa; multiple enchondromatosis and Maffucci's syndrome. More recently, the Bannayan syndrome and the Proteus syndrome have been documented among the causes. Unexplained hemihypertrophy may also occur in association with intra-abdominal neoplasms. The various entities are reviewed and their radiological features described and illustrated.     

The role of stressful life events in the onset of chronic primary headache

This study investigated the relationship between stressful life events and the onset of chronic primary headache (CPH), using both normative group ratings and self-report ratings of the desirability and the perceived impact of stressful events. We hypothesized that CPH patients (n = 63) would report significantly more stressful life events with negative impact on their life style in the year prior to headache onset compared with headache-free controls (n = 44). The prediction was fully confirmed. CPH patients were exposed to a significant increase (P less than 0.001) in their final year life change unit (LCU) totals prior to headache onset as compared to the previous corresponding time interval and to headache-free controls. Furthermore, a highly significant peaking (P less than 0.001) of negative change scores, based on personal ratings of the distress concerning life events in the same time interval, was observed in the CPH group. In terms of event content, exits or losses were prominent in being perceived as stressful. Significant differences between headache subgroups (chronic tension-type headache, migraine, mixed headache and psychogenic headache) were not found, although mixed headache sufferers reported a higher incidence of interpersonal arguments and difficulties than migrainous patients. We conclude that a sudden increase in the frequency and magnitude of stressful life events, associated with a cognitive-emotional appraisal of their negative impact on life patterns, appears to herald the onset of headache, independently of the developing clinical headache syndrome.     

Intensive care unit: how stressful for physicians?

The ICU has been considered a psychologically stressful environment. Although numerous studies have investigated this stress in ICU nurses, virtually none have examined how stressful the ICU is for physicians. This prospective study compares housestaff physicians' ratings of stress in the ICU to other medical-surgical rotations. The 26 physicians in this study rated the ICU significantly less negatively than other rotations. There was also a trend to rate the ICU more positively. Prolonged care of patients with multisystem failure and a poor prognosis was the most frequently described source of stress. Humor, communication, and activities outside the ICU were the most frequently noted coping techniques.     

间期荧光原位杂交技术检测慢性淋巴细胞白血病ATM基因缺失

目的探讨慢性淋巴细胞白血病(CLL)中ATM基因缺失及其与其他染色体异常及临床分期的相关性。方法运用间期荧光原位杂交技术(I-FISH)和Spectrum OrangeTM标记的位于11q22.3的序列特异性DNA探针ATM对50例初诊CLL患者的染色体标本进行了ATM缺失的检测,同时检测del(13q14)、del(17p13.1)和免疫球蛋白重链基因重排。临床分期按照Binet分期方法。结果50例患者中有6例(12%)ATM缺失;其中4例伴有其它染色体异常。20例Binet A期患者中,3例(15%)存在异常;10例Binet B期患者中,2例(20%)存在异常;13例Binet C期患者中,1例(7.7%)存在异常。ATM缺失在Binet A、B及C期中无统计学差异(P>0.05)。结论I-FISH与常规染色体分析技术相比是一种快速、准确及敏感的方法,对我国CLL患者的预后预测价值有待进一步的深入研究。     

Diogenes syndrome: The self-neglect elderly

Diogenes syndrome (DS) is characterized by severe self-neglect, domestic squalor, social withdrawal, syllogomania, and refusal of help that may be precipitated by stressful events. Secondary DS is related to mental disorders. Its management includes day care center and community care.     

Diogenes syndrome: The self-neglect elderly

Diogenes syndrome (DS) is characterized by severe self-neglect, domestic squalor, social withdrawal, syllogomania, and refusal of help that may be precipitated by stressful events. Secondary DS is related to mental disorders. Its management includes day care center and community care.     

Body composition and nutritional parameters in HIV and AIDS patients.

Undernutrition is a frequent complication of evolutive and chronic HIV (human immunodeficiency virus) infection characterized by bodyweight loss and changes in body composition. The Centers for Disease Control and Prevention define AIDS wasting as involuntary loss of more than 10% of body weight, plus more than 30 days of either diarrhea, or weakness and fever. Wasting syndrome has been considered as a case definition of the AIDS disease since 1987. Wasting syndrome is clearly linked to disease progression and death. Despite the progress under the era of highly active antiretroviral therapy (HAART), wasting is still a problem for people with AIDS. A small part of the weight lost is fat. More important is the loss of "lean body mass", which is mostly muscle. Body composition changes during HIV infection are different from those observed in food deprivation. Under the era of HAART, a HIV-associated adipose redistribution syndrome (HARS) was described that associates subcutaneous lipoatrophy and abdominal obesity linked to various metabolic disorders. Several factors contribute to wasting syndrome. Not only low food intake and poor nutrient absorption, but mainly altered metabolism (increased resting energy expenditure) and specific disturbances in protein turnover, which is also increased. Nutritional evaluation of HIV-infected patients should include the measurement of body composition and analysis of nutritional parameters, including albumin, transthyretin and C-reactive protein. Transthyretin seems to be particularly useful to follow the recovery period of malnutrition.